Friday 20 September 2019

BreastCheck screening has duty of candour

Mother-of-five Emma Mhic Mhathúna Photo: Don MacMonagle
Mother-of-five Emma Mhic Mhathúna Photo: Don MacMonagle
Eilish O'Regan

Eilish O'Regan

A lack of candour and openness were revealed in our national cancer screening service again this week. The focus shifted from CervicalCheck to BreastCheck and its failure to directly contact women who it was notified developed the disease in the two years after getting a clear mammogram X-ray.

BreastCheck has done reviews of many cases and inevitably discovered if a mistake was made.

In recent weeks, as the CervicalCheck scandal raged, BreastCheck refused to respond to questions on whether the service was doing internal reviews of these cases.

It took an appearance before the Oireachtas Health Committee to confirm the longest running of our screening programmes, in place since 2000, has been carrying out these re-checks of mammograms after being informed a woman whose last scan reading was clear went on to develop breast cancer.

A caseload of these reviews is likely to have built up for women screened up to the end of 2012. But BreastCheck is continuing to decline to say if it has many of these reviews on file. These reviews reveal if an error was made in analysing the woman's last mammogram and may explain why she was diagnosed with cancer between the two BreastCheck scans. Most women are well aware there are limitations to screening tests like mammograms. They have a failure rate like any test.

We know that the majority of women who develop cancer between scans have a disease which could not be picked up or was not possible to detect in a scan at the time.

But in around seven in every 100 women who develop these interval cancers, the mammogram result was wrong because the abnormalities were missed and something went wrong.

BreastCheck said it has given these reviews to any woman who asked for them.

Some doctors have also alerted patients to the reviews when they are diagnosed. But how many women are in the dark about the reviews?

A system of open disclosure, where women will be contacted once the review is complete, will not be in place until early next year.

In the meantime, there was much unnecessary scaremongering this week about the potential compensation payouts which may arise if women who develop cancer between scans take a legal case.

This route will only be open to a minority of women who must prove negligence.

It was disappointing to hear so much attention being given to the financial, rather than the human, cost.

BreastCheck, like other screening programmes, is obliged to tell women if they have been harmed.

But as yet it has no proper system in place to alert the patient to their review and provide back-up support such as counselling.

These reviews were previously seen by screening programmes as forms of internal audit which would throw light on error rates and signal where there may be weaknesses.

But the policy of open disclosure, where a patient must be told if they have been the victim of harm, has changed all that.

It will have implications for doctors and hospitals which also carry out internal audits.

The NHS breast screening service in England is leading the way in implementing a "duty of candour".

It states that a mammogram review should take place within six months of a woman being diagnosed with an interval cancer.

Interval cancers happen in one to two per 1,000 women screened. The service should write to the woman offering her a copy of the review and a meeting with her doctor.

BreastCheck said it is putting systems in place to roll out a similar open disclosure process here and is setting up training and counselling services.

There is much to credit in BreastCheck, which has identified 11,500 cancers .

But so much melodrama and distress for women could have been avoided with less silence.

Irish Independent

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